Ovarian abscess due to Actinomyces sp in absence of an intrauterine contraceptive device.

Ovarian abscess due to Actinomyces sp. in absence of an intrauterine contra ceptive device. The disease caused by Actinomyces spp. is often of difficul t diagnosis. Actinomyces spp. are anaerobic or microaerophilic non-spore-fo rming gram-positive rods that may reach, occasionally, the normal female ge nital tract. IUD and pessaries facilitate the access of the microorganisms to the pelvis. We report an unusual case of ovarian infection by Actinomyce s sp. in a 41 year-old female without IUD, admitted at the Institute in Nov ember 1998, with persistent fever. She had had an early menopause 3 years b efore, and had received hormonal replacement therapy. Usual and unusual inf ections were discarded by microbiological and serologic studies. Abdominal ultrasonography showed a slight left pyelocalycial dilatation and a simple cyst in the left ovary; heart ultrasonography was normal. Gynecological exa mination showed an enlarged uterus, similar to an 8 week pregnancy, painles s, and fixed anexial masses. The transvaginal ultrasonography showed uterin e myomas, one of them of 42 mm in the isthmus region, large ovaries, cystic , with acoustic shadows, and the left one with a septum. The preoperatory d iagnosis was infected bilateral cystic teratoma. The procedure was an explo ratory laparotomy, followed by a bilateral salpingo-oophorectomy. The speci men studies showed an endometrioma. with calcium deposits in the wall of th e right ovary, and an abscess in the left ovary, also with calcification of the wall. The sample from the left abscess developed Actinomyces sp. After surgery, and treatment with penicillin, the fever disappeared. It is impor tant to remark that the ovarian infection by Actinomyces sp. can also occur in patients without an IUD or a pessary; it might cause anexial images tha t can be interpreted as a tumour, inducing to erroneous diagnosis and treat ment.